Kohler’s Disease

Kohler’s Disease

What is Kohler's Disease? 

Kohler’s disease is a rare child’s foot condition that causes midfoot pain and limp. It is a type of osteochondrosis in children and is also known as avascular necrosis of the navicular bone and affects the inner side of the foot arch. Kohler’s disease commonly occurs in children between 3 and 7 years old and is more common in boys. If left untreated, the condition can limit the foot motions and change your child’s gait pattern.

Kohler's disease, osteochondrosis of the navicular bone in Singapore.


Children with Kohler’s disease often report pain, redness and swelling in the midfoot, causing them to limp or have difficulty putting weight on the affected foot. They may also have a limited range of movement of the affected foot.

What Causes Kohler's Disease?

Current available studies cannot explain the exact cause of Kohler’s disease. Still, there are some proposed theories, and they include the following:

  • A disruption of blood supply to the navicular bone leads to the weakening and collapse of the bone structure.
  • The navicular is one of the late bones in the midfoot to mature, making it the weakest and prone to compression and trauma when the child is weight-bearing.

How to Diagnose Kohler's Disease?

A thorough assessment, patient’s history and medical history are crucial for diagnosing Kohler’s disease. Generally, an X-ray image of the foot is necessary to visualise the shape of the navicular bone. Any further scans, such as MRI or CT scan, may only be required if the diagnosis is unclear.

Treatment of Kohler's Disease in Singapore

Kohler’s disease is generally considered a self-limiting condition and will heal over time. However, as the condition is painful and affects the child’s quality of life, the primary goal of treatment is to reduce pain and further trauma.

Treatment options include:

  • Rest: Avoiding weight-bearing activities will reduce compression and trauma to the navicular bone
  • Wearing a walking boot: A walking boot, usually put on for 4 to 6 weeks, will immobilise the foot and allow the foot to heal without further trauma.
  • Custom orthotics: custom insoles can help by providing support and redistributing pressure on the affected area.
  • Over-the-counter medications: Anti-inflammatory drugs can help to relieve pain but should only be used under the guidance of a medical professional
  • Physical therapy: Rehabilitation is a necessary part of recovery as we need to improve the foot’s range of motion and strengthen the lower leg muscles after the period of rest


The good news of Kohler’s disease is that the prognosis is generally good. Most children will recover within 6 to 24 months. However, following the recommended management plan and monitoring the child’s progress over time is essential to ensure proper healing and prevent complications.

The long-term implications of poorly recovered patients are chronic foot pain, foot deformities (such as collapsed foot arch) or a change in the gait patterns.


Kohler’s disease is rare but can cause significant pain and debilitation in walking in affected children. Early detection and a strict management plan are crucial for a good outcome. By understanding its causes, symptoms, diagnosis, and management options, parents and we, as podiatrists, or other medical professionals, can work together to ensure that your child receives the necessary care and support for a full recovery.

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Many other foot conditions in children can mimic the symptoms of Kohler’s Disease, such as posterior tibial tendonitis, spring ligament sprain, or even a foot infection. If your child complains of pain, redness, and swelling in the midfoot or is limping, you should bring your child to see a paediatric podiatrist or a medical professional as soon as possible.

There is no surefire way to prevent Kohler’s disease in children. However, you can take measures to reduce the risk of it developing, and that includes:

  1. Participating in age-appropriate activities: A growing young child should avoid strenuous, high-impact activities that can cause significant impact and trauma to the foot.
  2. Maintaining a healthy body weight: This can reduce the load on the foot, especially when walking or running.
  3. Wearing appropriate footwear: Supportive footwear with a firm heel counter and shank is essential in preventing foot injuries in children.
  4. Listening to your child: Paying attention to your child’s complaints and regularly monitoring their foot is important to detect early signs or symptoms.

The good news about Kohler’s disease is that surgery is usually not needed unless a severe complication or deformity is present following the condition. This condition is self-limiting and takes time to recover on its own. Therefore, your child should heal within 6 to 24 months with a proper management plan.

No studies suggest that flat feet increase the risk of developing Kohler’s disease. However, theoretically, a collapsed foot arch can increase the stress on the navicular bone, which may cause the condition to develop.

Kohler’s disease is a condition that specifically affects children. However, a similar condition occurs in adults, known as Mueller-Weiss Syndrome, which causes the navicular bone to collapse. The Mueller-Weiss syndrome has a more significant impact on the foot structure. It can lead to the early development of foot arthritis.